The NHS is moving towards collaborative working in systems, with trusts, primary care, local authorities, emergency services and the voluntary, community and social enterprise (VCSE) sector coming together to improve the health of the population and join up care. As part of the wider move towards collaboration in local systems, the national bodies are also developing a new operating model, with a view to increasing workforce devolution to regions, ICSs and local organisations, using the ICS maturity matrix to benchmark workforce planning capabilities and determine where workforce planning should be undertaken at a devolved level.

However, all of this is taking place in the context of increasingly severe pressures across the NHS and care sector. 2018/19 Q4 performance figures showed a £700m deterioration in the underlying provider sector deficit in a year. Demand for services is increasing, with a 5.4% rise in emergency admissions from 2017/18, and the provider sector has missed the A&E four-hour waiting standard in every month since July 2015. The NHS is seeing more patients than ever, but demand now substantially outstrips supply. Social care and public health also face severe pressures due to reductions in local government funding, coupled with rapidly increasing needs among the older and disabled population. Rising levels of unmet social care need has contributed to the increase in demand for NHS services as vulnerable people turn to the NHS for support and spend longer in hospital waiting for care packages to be put in place at home.

The NHS and its workforce are consequently under increasing strain. Although the overall size of the workforce is growing, there are around 100,000 reported vacancies in the NHS, almost 40,000 of which are nursing vacancies. The NHS people plan aims to tackle workforce challenges by making the NHS a better place to work, encouraging new staff to train and work in the NHS, and improve retention and staff wellbeing. While the pledges within the people plan to grow the workforce are welcome, there is a pressing need to support the existing workforce, and to ensure staff are deployed as effectively as possible across a population to deliver those commitments.

This briefing aims to explore how trusts are working with their staff and with local partners to enable the health and care workforce to adapt to new ways of collaborative working in systems, and to support the aim of integrated, joined up care. It contains a number of case studies based on interviews with trusts, STPs and ICSs and local authorities, which explore new, devolved ways of organising and planning for workforce needs, and of deploying, recruiting and retaining staff in a system context. We would like to thank all of the interviewees who contributed to this publication for sharing their learning and insights to date.